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General NPI Number Information
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NPI Number | 1083369847
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Entity Type | Individual
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Provider Name | NICOLE ALEXANDRIA PUGH-MARTIN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2022
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 653 W EDGAR RD
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City | LINDEN
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State | NJ
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Zip | 07036-6574
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Country | US
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Telephone | 610-905-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 653 W EDGAR RD # 1248
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City | LINDEN
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State | NJ
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Zip | 07036-6574
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Country | US
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Telephone | 610-905-3752
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 2020010822
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2020010822
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License Number State | PA
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